Provider Demographics
NPI:1033289244
Name:KANE, J TIMOTHY
Entity Type:Individual
Prefix:MR
First Name:J
Middle Name:TIMOTHY
Last Name:KANE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 W EAGLE RD
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-1447
Mailing Address - Country:US
Mailing Address - Phone:610-449-9393
Mailing Address - Fax:610-446-1735
Practice Address - Street 1:56 W EAGLE RD
Practice Address - Street 2:
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-1447
Practice Address - Country:US
Practice Address - Phone:610-449-9393
Practice Address - Fax:610-446-1735
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1066750001Medicare ID - Type UnspecifiedPROVIDER